title: Accuracy assessment of catheter guidance technology in electrophysiology procedures: a comparison of a new 3D-based fluoroscopy navigation system to current electroanatomic mapping systems.
abstract: BACKGROUND
  With increasing complexity in electrophysiology (EP) procedures, the use of electroanatomic mapping systems (EAMS) as a supplement to fluoroscopy has become common practice. This is the first study that evaluates spatial and point localization accuracy for 2 current EAMS, CARTO3(®) (Biosense Webster, Diamond Bar, CA, USA) and EnSite Velocity(®) (St. Jude Medical Inc., St. Paul, MN, USA), and for a novel overlay guidance (OG) software (Siemens AG, Forchheim, Germany) in a phantom experiment.
  
  
  RESULTS
  A C-arm CT scan was performed on an acrylic phantom containing holes and location markers. Spatial accuracy was assessed for each system using distance measurements involving known markers inside the phantom and properly placed catheters. Anatomical maps of the phantom were acquired by each EAMS, whereas the 3D-based OG software superimposed an overlay image of the phantom, segmented from the C-arm CT data set, onto biplane fluoroscopy. Registration processes and landmark measurements quantitatively assessed the spatial accuracy of each technology with respect to the ground truth phantom. Point localization performance was 0.49 ± 0.25 mm in OG, 0.46 ± 0.17 mm in CARTO3(®) and 0.79 ± 0.83 mm in EnSite(®) . The registration offset between virtual visualization and reality was 1.10 ± 0.52 mm in OG, 1.62 ± 0.77 mm in CARTO3(®) and 2.02 ± 1.21 mm in EnSite(®) . The offset to phantom C-arm CT landmark measurements was 0.30 ± 0.26 mm in OG, 0.24 ± 0.21 mm in CARTO3(®) and 1.32 ± 0.98 mm in EnSite(®) .
  
  
  CONCLUSIONS
  Each of the evaluated EP guidance systems showed a high level of accuracy; the observed offsets between the virtual 3D visualization and the real phantom were below a clinically relevant threshold of 3 mm.
authors.affiliation: The Lucas Center, Department of Radiology, Stanford School of Medicine, Stanford, California, USA; Department of Cardiovascular Diseases (partner site Munich Heart Alliance), German Heart Centre, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fahrig
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Klaus
authors.initials: K
authors.lastname: Kurzidim
authors.forename: Norbert
authors.initials: N
authors.lastname: Strobel
authors.forename: Teri
authors.initials: T
authors.lastname: Moore
authors.forename: Cameron
authors.initials: C
authors.lastname: Hinkel
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods / Q000592:standards*; D017115:Catheter Ablation / Q000379:methods / Q000592:standards*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods / Q000592:standards*; D005471:Fluoroscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000592:standards*
keywords: C-arm CT; CARTO; EnSite; atrial fibrillation; catheter ablation; image integration; registration